Late referral and lack of dialysis access are independent predictors of mortality in elderly patients commencing dialysis. It is important that ongoing studies assess not just days survived but also the QOL of dialysis or non-dialysis management pathways on patients, carers and staff. The elderly can have specific medical issues and needs that are best assessed by an Aged Care Physician. This is recommended particularly when

assessment of cognitive function is a part of the considerations in determining whether dialysis is appropriate or not. One of the key issues in renal medicine is knowing when a patient will have renal dysfunction or symptoms severe enough to warrant dialysis if that is their chosen treatment pathway. A number of models have been tested to help predict the likelihood of progressing to ESKD from earlier stages of CKD. Reasonable but by no means exclusive recommendations are as follows: For CKD stage 3–5 patients: GDC-0980 ic50 The JAMA Kidney Failure Risk Equation in patients with CKD stages 3–5 helps predict progression through CKD stages. For patients being considered for a non-dialysis pathway (particularly the elderly): The clinical score by Couchoud which provides a mortality risk score obtained from nine risk

factors For dialysis selleckchem patients being considered for transition to a non-dialysis pathway (particularly the elderly with co-morbidities): Predictive testing as above, plus The clinical score by Cohen involving a mortality score obtained from combining the answer to the ‘Surprise Question’ with four routine variables – age, serum albumin, presence of dementia and peripheral

vascular disease Patients with ESKD are known to have a worse QOL than an age-matched general population; sometimes this can be helped by better attention to dialysis delivery or anaemia management but in some cases QOL on dialysis remains poor despite every effort to optimize dialysis and ESKD medical management. Without asking the right questions, Cobimetinib mouse or preferably using a validated tool to assess QOL, we will not really know which patients have satisfactory or poor QOL. What constitutes a poor QOL varies from person to person and the potential impact of dialysis on an individual will be unique for each person; it is important that this is discussed openly between the patient and his/her treating clinicians. Commonly reported dimensions of QOL surveys are: physical function, role limitations-physical, bodily pain, vitality, general health perceptions, role limitations-emotional, social function, and mental health. These self-reported dimensions are influenced by a multitude of outside factors such as social situation, environmental factors, financial situation, symptoms experienced, personal values and psychological factors. The SF-36 QOL questionnaire is a suitable tool that can be used in dialysis and non-dialysis patients to assess changes in QOL.